Whale concept—folding mesh for TIPP procedure for inguinal hernia

ABSTRACT

The present invention relates to a device ( 1 ) for introducing a flexible prosthesis into a surgical incision, comprising a globally tubular body ( 2 ) having a proximal end ( 2   a ) and a distal end ( 2   b ), said tubular body being designed for receiving the prosthesis in a folded configuration in a sliding way,
         wherein the tubular body is provided with an open longitudinal slit ( 3 ) extending from said proximal end ( 2   a ) to said distal end ( 2   b ), and wherein said distal end is provided with a distal semi-tubular rounded extension ( 2   c ).

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims benefit of and priority to European Patent Application Serial No. 14306522.5 filed Sep. 29, 2014, the disclosure of the above-identified application is hereby incorporated by reference in its entirety.

The present invention provides a device for introducing a flexible prosthesis, for example for repairing hernias, in an incision of small size. The present invention further relates to a kit comprising such a device and a flexible prosthesis intended to be introduced in a patient via said device.

In this application, the “medial” end or part of an element of a prosthesis is to be understood as meaning the end or part of the element located in the direction of the median plane of the body when the prosthesis is implanted in the body. The “lateral” end or part of an element of a prosthesis is to be understood as meaning the end or part of the element located in the direction of the outwards lateral plane of the body when the prosthesis is implanted in the body. Likewise, in this application, the “medial direction” is to be understood as meaning the direction towards said median plane and the “lateral direction” is opposite the “medial direction”, the medial and lateral directions being aligned on the same axis, the medial-lateral axis. In this application, the “cranial” end or part of an element of a prosthesis is to be understood as meaning the end or part of the element located substantially in the direction of the head of the body when the prosthesis is implanted in the body. The “caudal” end or part of an element of a prosthesis is to be understood as meaning the end or part of the element located in the direction of the feet of the body when the prosthesis is implanted in the body. Likewise, in this application, the “cranial direction” is to be understood as meaning the direction towards said head and the “caudal direction” is opposite the “cranial direction”, the cranial and caudal directions being aligned on the same axis, the cranial-caudal axis.

In humans the abdominal wall consists of fat and muscles interconnected by aponeuroses. A break in continuity may occur at the level of the aponeuroses, allowing part of the peritoneum to pass through and form a sac, known as a hernia, containing either fat or a portion of the intestine. Hernias or ventral ruptures (hernias occurring on a parietal surgical scar) are manifested by a protrusion on the surface of the skin and are called umbilical or inguinal hernias or ventral ruptures, for example, as a function of their location.

To repair a hernia, surgeons often fit a synthetic mesh prosthesis that replaces or reinforces the weakened anatomical tissue.

In the case of umbilical or inguinal hernias, for example, or when the aim of treatment is to repair trocar holes or preventive, the size of the defect to be treated is small, for example from 1 to 4 cm diameter, and open surgery may be envisaged without widening the defect. However, in this type of surgery, the surgeon has little working space and little visibility. It would be desirable to have in possession a device suitable for introducing the prosthesis into such a small incision without having to grasp the prosthesis with an additional instrument. It would also be desirable that the prosthesis does not touch the incision edges during the introduction step.

Some flexible prostheses, such as textile based prostheses, may be adapted to occupy a small volume in a first configuration in which they are folded up on themselves and to be deployed and spread out in a second configuration corresponding to an implantation configuration.

Various prostheses that may be folded up and then deployed are available. Some of them are provided with a resilient reinforcing element capable of automatically restoring its initial shape to the prosthesis after said prosthesis has been folded up on itself.

Inguinal hernias relate to defects to be treated in the inguinal anatomical region. The inguinal region comprises the intersection of a parietal plane comprising the orifice of the inguinal canal and of a vascular plane comprising the iliac vessels and the spermatic cord when the patient is a man. The shape of a prosthesis intended to be used for treating an inguinal hernia will be asymmetric and dependent on the side (right or left) of the body that is to be treated. In this view, the shape of a prosthesis for treating an inguinal hernia may be defined in relation with the position of the prosthesis once implanted in the body of a patient. For example, in an implanted configuration, a prosthesis for treating an inguinal hernia comprises a medial part, a lateral part, a caudal part, and a cranial part as defined above. A prosthesis intended to be used in the treatment of an inguinal hernia will generally have an elongate shape with a longitudinal axis substantially aligned on the medial-lateral axis of the body.

A first aspect of the present invention is a device for introducing a flexible textile based prosthesis into a surgical incision, comprising a globally tubular body having a proximal end and a distal end, said tubular body being designed for receiving the prosthesis in a folded configuration in a sliding way, wherein the tubular body has a substantially oblong cross-section and is provided with an open longitudinal slit extending from said proximal end to said distal end.

In this application, the distal end of a component or of a device is to be understood as meaning the end furthest from the surgeon's body and the proximal end is to be understood as meaning the end closest to the surgeon's body when the surgeon is completing the surgical operation. Likewise, in this application, the “distal direction” is to be understood as meaning the direction of implantation, namely towards the patient body, and the “proximal direction” is to be understood as meaning the opposite direction to said direction of implantation.

Thanks to the shape of the device and of the presence of the longitudinal slit, the prosthesis may be easily folded up and introduced into the device without having to use an additional tool. The oblong cross section of the tubular body is particularly adapted for a facilitated progression of a folded prosthesis inside the device. Furthermore, the walls of the tubular body of the device allow the prosthesis to avoid touching the incision edges in an open surgery method, even if the incision is of very small size, for example is less than 4 cm or 3 cm long.

The presence of the longitudinal slit in the device of the invention also allows compression of the walls of the tubular body and therefore reduction of the cross sectional area of the device, thereby facilitating the insertion of the device into the incision. The presence of the longitudinal slit further allows a direct access to the prosthesis by a hand of the surgeon for example or by a tool, for maintaining the prosthesis into the body of the patient at the time the device of the invention is removed from the incision.

As will appear from the description below, the device of the invention allows a standardized gesture of the surgeon. The device of the invention guarantees the surgeon that the incision he has made is sufficient and that the prosthesis will be delivered at the right place. The device of the invention further allows the surgeon to confirm and or redesign the dissection he has made at the implantation site.

In embodiments, said distal end is provided with a distal semi-tubular rounded extension. The distal semi-tubular rounded extension may for example have the global shape of a spatula. The distal semi-tubular rounded extension of the distal end of the device allows an easy introduction of the device into a small incision, for example an incision of 3 or 4 cm long. The rounded shape of the distal semi-tubular extension will not damage the surrounding biological tissues, such as the peritoneum. In addition, the distal semi-tubular rounded extension may be used for further dissection if the dissection pocket completed by the surgeon in the first place proves to be too small in the end.

In embodiments, the proximal end is provided with a proximal semi-tubular extension forming a partial funnel. Such a shape allows an easier introduction of the folded prosthesis in the tubular body. In addition, such a shape helps an automatic folding of the prosthesis into the tubular body, as the sloped walls of the proximal end of the tubular body naturally urge the prosthesis towards the inside of the tubular body.

In embodiments, said device comprises markings defining a ruler. For example, markings are provided on the tubular body for forming a ruler. Such markings may help the surgeon determine whether he has dissected an adequately long enough pocket for the insertion of the prosthesis. Such markings are more accurate than the “finger” measurement system usually used by surgeons. Such markings may therefore help avoid the situation where the surgeon attempts to position the prosthesis at the implantation site only to discover that he has not dissected enough and that he must remove the prosthesis, dissect further and then re-introduce the prosthesis. Such embodiments with markings therefore allow saving time and avoiding potential irritation and infection.

In embodiments, the tubular body is made of a transparent material. Such embodiments allow a good visibility of the folded prosthesis inside the tubular body. Such embodiments allow the surgeon to check the sliding and movement of the prosthesis from the proximal end of the tubular body to its distal end up to the ejection of the prosthesis from the device of the invention.

In embodiments, the tubular body is made from a material selected from poly(ethylene terephthalate) glycol (PETG), polyethylene terephthalate (PET), polypropylene, polycarbonate and mixtures thereof. These materials provide to the walls of the tubular body a smooth surface facilitating on one hand the sliding of the prosthesis inside the tubular body and easing on the other hand the introduction of the device in the incision.

Another aspect of the present invention is a kit comprising a device as described above and a prosthesis of generally elongate shape defining a longitudinal axis A aligned on a medial-lateral axis and a transversal axis B aligned on a cranial-caudal axis, said prosthesis comprising:

-   -   at least one flexible biocompatible textile of elongate shape         comprising a medial end, a lateral end, a cranial part and a         caudal part, said textile being delimited by a peripheral outer         edge formed of a convex medial edge, a convex cranial edge, a         convex lateral edge and a caudal edge, and     -   at least one reinforcing element for said textile, said         reinforcing element being in the form of a resilient frame         connected to said textile and set back from the peripheral outer         edge.

According to the present invention, “textile” is understood as any arrangement or assembly of biocompatible yarns, fibres, filaments and/or multifilaments, for example obtained by knitting, weaving, braiding, or non-woven.

In the present application, “biocompatible” is understood as meaning that the materials having this property can be implanted in the human or animal body.

Within the meaning of the present application, a “flexible textile” is understood as a textile that can be folded up but that does not have an inherent elasticity allowing it to spontaneously recover a spread-out configuration once it has been folded up.

Within the meaning of the present application, a “resilient frame” is understood as a frame which, for example, can be semi-rigid and has a resiliency or elasticity allowing it to be deformed under the effect of a temporary stress and allowing it to return to an initial state of rest once said stress has been removed. According to the present invention, the frame allows the textile, and therefore the prosthesis, to be pressed together in the transversal direction towards the longitudinal axis of the textile.

The prosthesis above is intended to be introduced in the body of the patient and to be conveyed to the implantation site with the device of the invention. The prosthesis is able to be folded up along at least one folding direction in a very simple way, for example by pressing the frame together, in one hand, transversally in the direction of the longitudinal axis of the prosthesis. Thus, the prosthesis is capable of adopting an elongate configuration, which is very compact in the transversal direction, allowing it to be introduced in the tubular body of the device of the invention. The frame is sufficiently resilient to allow the prosthesis to be folded in order to enter the proximal end of the tubular body. When the prosthesis emerges from the distal end of the tubular body, it tends to spread out automatically under the action of the frame, which tends to recover its initial configuration in the absence of the stresses from the walls of the tubular body. The prosthesis is capable of conforming to the anatomical structures and of remaining in place once it is positioned at the implantation site.

In embodiments, the frame comprises a convex cranial segment extending from the medial end of the textile to the lateral end of said textile along said convex cranial edge, a caudal segment substantially extending from the medial end of the textile to the lateral end of said textile and caudally spaced with respect to said convex cranial segment, a lateral corner segment joining together the convex cranial segment and the caudal segment in the region of the lateral end of the textile, and a folding segment configured for joining a medial end of said convex cranial segment to a point located on the caudal segment while leaving the region of the medial end of the textile free of any frame,

said frame being able to adopt an unstressed configuration, in which said textile is deployed, and a stressed configuration, in which said frame is subjected to a transversal force directed towards said longitudinal axis A, and said convex cranial segment, said caudal segment and said folding segment are substantially collected together and aligned on one folding direction, said textile forming thereby at least one fold along said folding direction.

The specific shape of the frame allows facilitating the folding of the prosthesis and thus its introduction in the device of the invention. The respective shapes of the convex cranial segment, the caudal segment and the folding segment allow these segments to be able to converge together and to be aligned on one folding direction when a transversal pressure is exerted on the frame. The absence of any frame structure in the region of the medial end of the textile allows the convex cranial segment and the caudal segment to be brought close together, for example side by side or alternatively one on the top of the other, at the time of the folding of the prosthesis. The transversal volume occupied by the prosthesis is therefore reduced, making it easier to introduce the prosthesis into the proximal end of the tubular body of the device of the invention, in the direction of the longitudinal axis of the prosthesis.

The materials that may be suitable for producing the frame of the prosthesis according to the kit of the invention may be chosen from any biocompatible material having a certain rigidity in order to meet the requirements described above.

In one embodiment, the frame is made of a bioresorbable material. In the present application, “bioresorbable” or “biodegradable” is understood to mean that the materials having this property are absorbed and/or degraded by the tissues or washed from the implantation site and disappear in vivo after a certain time, which may vary, for example, from a few hours to a few months, depending on the chemical nature of the materials.

Thus, the frame may act as a guide for the prosthesis for introducing said prosthesis into the tubular body of the device of the invention, then may act as a means of stiffening the prosthesis during the positioning and implanting of the prosthesis, after which it may gradually degrade when the textile has been recolonized by the surrounding cells.

For example, the bioresorbable material can be chosen from among polylactic acid (PLA), polycaprolactones (PCL), polydioxanones (PDO), trimethylene carbonates (TMC), polyvinyl alcohol (PVA), polyhydroxyalkanoates (PHA), oxidized cellulose, polyglycolic acid (PGA), copolymers of these materials and mixtures thereof. For example, the bioresorbable material can be a copolymer of polylactic acid and of polyglycolic acid.

Alternatively, the frame of the prosthesis according to the invention is made of a non-bioresorbable material chosen from among polypropylenes, polyesters such as polyethyleneterephthalates, polyamides, silicones, polyether ether ketone (PEEK), polyarylether ether ketone (PAEK), polyurethanes and mixtures thereof.

In another embodiment, said frame is formed by a combination of bioresorbable material and of non-bioresorbable material.

In the prosthesis of the kit of the invention, the caudal segment of the frame may serve as a positioning guide for the surgeon, this caudal segment preferably having to be placed in the inguinal region at the intersection of the parietal and vascular planes to permit optimal positioning of the prosthesis. In one embodiment of the invention, said caudal segment may form a fold of the textile, said fold causing said caudal part of said textile to form naturally an angle to the plane of said cranial part of said textile. Thus, the caudal segment may give the textile a three-dimensional shape, similar to the anatomy of the inguinal region, by forming a fold in the textile, in such a way that the caudal part of the textile tends naturally to form an angle with the cranial part of said textile, this angle corresponding to the angle formed anatomically by the intersection of the parietal and vascular planes.

In embodiments, said caudal segment is concave. Such a shape allows an easy pressing of the frame and therefore of the prosthesis, and a significant reduction of the volume occupied by the prosthesis in the transversal direction. In addition, the concavity of the caudal segment confers to the caudal part of the textile an undulated and anatomical developed shape for matching the general shape of the lower inguinal structures, especially the spermatic and iliac vessels and the psoas muscle.

In embodiments, the folding segment joins the medial end of said convex cranial segment to a medial end of the caudal segment. For example, the folding segment has a U shape extending towards a center of the textile. In such embodiments, when pressing the frame transversally, the two legs of the U of the folding segment converge together with the convex cranial segment and the caudal segment, allowing a significant reduction of the volume occupied by the prosthesis in the transversal direction.

In one embodiment, said frame is continuous. Thus, the step of pressing the prosthesis together, by pressing the frame together towards the longitudinal axis of the prosthesis, does not create any projecting elements that could potentially perforate and damage the tissues. By virtue of its nature and its shape, the frame only has rounded and atraumatic outer contours.

In embodiments, at least a part of said frame, for example at least a part of the caudal segment, has substantially the structure of a flat band forming undulations substantially in the plane of said textile. Such undulations allow a good conformability of the prosthesis in general, and a good flexibility to the caudal segment in particular at the intersection of the parietal and vascular planes. Such undulations can expand and contract to further confer a greater flexibility to the frame. The step of introducing the prosthesis inside the tubular body of the device of the invention is therefore facilitated. In addition, such undulations confer a good resistance to folding to the prosthesis.

In embodiments, said frame further comprises a caudal extension located on the caudal segment and extending in the caudal direction toward the caudal edge of the textile. The caudal extension helps deploying the caudal part of the textile once the prosthesis is implanted. This caudal extension helps spreading out the caudal part of the textile on the biological tissues it is intended to cover, namely the iliac and spermatic vessels and part of the psoas muscle.

The frame of the prosthesis according to the invention is connected to said textile. For example, the frame can be fixed to the textile by sewing, ultrasonic welding, or else by adhesive bonding or moulding.

In one embodiment, the frame of the prosthesis according to the kit of the invention is moulded over the textile. Thus, the frame is connected to the textile by injection moulding of one or more thermoplastic or thermosetting biocompatible materials. For example, the mould of an injection-moulding machine is equipped with an insert gate in which the textile is held. One or more thermoplastic or thermosetting biocompatible materials are then heated to their melting point and injected into the mould, the latter having one or more channels of the shape desired for the frame. The holding of the textile, the precision of the injection volume and the choice of the injection parameters make it possible to obtain a frame without material loss, without flash and with good surface evenness. Such a method allows the frame to be fixed to the textile in a particularly effective and lasting way.

In one embodiment, the frame is obtained by moulding a copolymer of polylactic acid and of polyglycolic acid over the textile.

The textile of the prosthesis according to the kit of the invention has a generally elongate shape, for example oval or elliptic. The textile can have another initial shape and can then be cut to such an elongate shape, in particular to a shape adapted to the defect, for example the hernia defect of the inguinal region, that is to be treated. In particular, the shape of the textile of the prosthesis of the invention comprises a part capable of efficiently covering the anterior muscle wall, the orifice of the inguinal canal, the upper part of the os pubis and Cooper's ligament, and a part capable of covering efficiently the iliac vessels and spermatic vessels and part of the psoas muscle. The textile is delimited by a peripheral outer edge formed of a convex medial edge, a convex cranial edge, a convex lateral edge and a caudal edge. The caudal edge may be flat or convex. Preferably, the caudal edge is convex in order to optimize the covering of the iliac vessels and spermatic vessels and part of the psoas muscle. As such, the general shape of the peripheral outer edge is preferably convex.

The textile may be bioresorbable, permanent or partially bioresorbable. In embodiments, the textile is bioresorbable. Bioresorbable textiles may be made from low density meshes or knit designs. In embodiments, for example when the prosthesis is not intended to remain permanently in the body of a patient, both the frame and the textile are bioresorbable. For example, the frame is bioresorbable in a time frame comparable to the textile. The shape and nature of the frame of the prosthesis of the invention allow providing a prosthesis based on a low density bioresorbable textile capable of offering sufficient strength for performing its repair function and sufficient rigidity for being efficiently manipulated while at the same time limiting the amount of foreign material implanted.

In one embodiment, the textile is a mesh.

Within the meaning of the present application, a “mesh” is understood as a textile, as defined above, which is openworked, that is to say provided with pores that favour recolonization of tissue. It is sufficiently flexible to be folded up at the time of introduction into the abdominal cavity. The mesh can be made from a layer of textile or several layers of textile. Such meshes are well known to a person skilled in the art.

In one embodiment of the invention, the mesh is a knit. By virtue of the meshwork of the knit, it is possible to obtain openworked faces that promote cell recolonization after implantation.

Another aspect of the present invention is a method by which a prosthesis as described above is conveyed to an implantation site of the inguinal region during an open surgery procedure, said method comprising the following steps:

-   -   an incision of size ranging from 3 to 4 cm is completed on the         abdominal skin,     -   the above prosthesis is pressed together and/or folded upon         itself, by applying a transversal pressure on the frame, so that         said textile forms a fold along the folding direction, and said         convex cranial segment, said caudal segment and said folding         segment are substantially collected together, for example side         by side or one on top of the other, and aligned on one folding         direction,     -   the medial end of the prosthesis is approached towards the         proximal end of the tubular body of the device of the invention         and the folded prosthesis is at least partially introduced into         the tubular body,     -   the distal end of the tubular body is introduced into the         incision and pushed in the distal direction up to the         implantation site,     -   the surgeon pushes distally on the prosthesis so as to make it         slide into the tubular body and be conveyed to the implantation         site in the inguinal region,     -   the surgeon maintains the prosthesis in place by accessing the         prosthesis via the longitudinal slit while pulling on the         tubular body in the proximal direction for removing the device         of the invention from the body of the patient,     -   when the device of the invention is removed, the pressure         previously exerted on the frame by the walls of the tubular body         is released and the prosthesis automatically starts deploying by         means of the frame tending to come back to its unstressed         configuration.

The present invention will emerge more clearly from the description given hereinafter and from the appended drawings, in which:

FIG. 1 is a representation in section of a median abdominal hernia or ventral rupture,

FIG. 2 is a simplified view of the hernia from FIG. 1 after the surgeon has made an abdominal incision and removed the hernia sac,

FIG. 3 is a top view of one embodiment of the device of the invention,

FIG. 4 is a top view of an embodiment of a flexible prosthesis of the kit of the invention,

FIG. 5 is a top view showing the step before introduction of another embodiment of a prosthesis of the kit of the invention in the device of FIG. 3,

FIG. 6 is a top view of the folded prosthesis of FIG. 5 partially introduced in the device of the invention.

FIG. 1 represents a hernia defect 100 of the abdominal wall 101 that is characterized by a break in the continuity of the aponeurosis 102 surrounding the straight muscles 103 and a passage through the peritoneum 104 forming a sac, the hernia sac 105, that contains either fat (epiploon) or part of the viscera 106, and which then presses on the fatty tissues 107 and is flush with the skin 108. One treatment of a hernia defect 100 entails replacing and retaining the viscera 106 in the abdominal cavity 109.

FIG. 2 shows the hernia defect 100 from FIG. 1 after the surgeon has made an incision 110 in the skin 108, the abdominal wall 101 and the peritoneum 104 and has reduced the hernia sac. The viscera are not shown in FIG. 2: they have been pushed back into the abdominal cavity 109. The surgeon must now introduce into the abdominal cavity 109, via the incision 110 that has been made, a prosthesis for reinforcing the abdominal wall, before closing the incision 110 by means of sutures, for example. In the case of treatment of an umbilical or inguinal hernia by open surgery procedure, the size of the incision 110 is particularly small, for example of the order of 1 to 4 cm diameter.

With reference to FIG. 3 is shown an embodiment of a device 1 according to the invention. The device 1 of the invention is intended to be used for introducing a flexible prosthesis, such as the prosthesis 10 shown on FIG. 4, in a body incision such as the incision 110 of FIG. 2.

The device 1 comprises a globally tubular body 2 having a proximal end 2 a and a distal end 2 b. The tubular body 2 has an oblong cross section and is provided with an open longitudinal slit 3 extending from the proximal end 2 a to the distal end 2 b. Such a shape allows an easy introduction and movement of the folded prosthesis 10 inside the device 1.

The distal end 2 b is further provided with a distal semi-tubular rounded extension 2 c. On the example shown, the distal semi-tubular rounded extension 2 c forms a single piece with the tubular body 2. In other embodiments, the distal semi-tubular rounded extension could be an added element and/or formed from another material than that of the tubular body 2. The distal semi-tubular rounded extension 2 c is intended to be introduced first in the incision 110 of the body of the patient. Its distal rounded shape allows an easy introduction of the device 1 in an incision, even if the incision is of very small size, such as 3 or 4 cm long. In addition, the semi-tubular shape of the distal semi-tubular rounded extension 2 c facilitates the ejection of the prosthesis from the device 1 at the time the prosthesis is delivered on the implantation site.

The distal semi-tubular rounded extension 2 c may also be used for further dissection if the dissection pocket completed by the surgeon in the first place proves to be too small in the end.

The longitudinal slit 3 facilitates the sliding of the prosthesis inside the tubular body 2, from the proximal end 2 a to the distal end 2 b.

The proximal end 2 a of the tubular body 2 is provided with a proximal semi-tubular extension 2 d forming a partial funnel. On the example shown, the proximal semi-tubular rounded extension 2 d forms a single piece with the tubular body 2. In other embodiments, the proximal semi-tubular rounded extension could be an added element and/or formed from another material than that of the tubular body 2. The partial funnel formed by the proximal semi-tubular extension 2 d allows an easier introduction of the folded prosthesis in the tubular body. In addition, such a shape helps an automatic folding of the prosthesis into the tubular body, as the sloped walls of the proximal end of the tubular body naturally urge the material forming the prosthesis, for example a mesh, towards the inside of the tubular body.

With reference to FIG. 3, the device 1 is further provided with markings 4 distributed along the length of the tubular body 2. These markings define a ruler. Such a ruler may help the surgeon measuring the length of the dissection he has completed. In particular, the surgeon may thus determine whether he has dissected an adequately large enough pocket for the insertion of the prosthesis. The presence of a rule on the tubular body 2 is more accurate than the “finger” measurement system usually used by surgeons. The situation where the surgeon attempts to position the prosthesis at the implantation site only to discover that he has not dissected enough and that he must remove the prosthesis, dissect further and then re-introduce the prosthesis may therefore be avoided with the device 1 of the invention. The device of the invention may therefore allow saving time and avoiding potential irritation and infection.

The tubular body 2 may be made of any biocompatible material such as plastic material usually used in surgical applications. The tubular body 2 is preferably made of a transparent material. The surgeon is thus able to easily check the position of the folded prosthesis inside the tubular body 2, as well as the sliding and movement of the prosthesis from the proximal end of the tubular body to its distal end. He can then easily proceed to the ejection of the prosthesis at the implantation site.

The tubular body may be made from a material selected from poly(ethylene terephthalate) glycol (PETG), polyethylene terephthalate (PET), polypropylene, polycarbonate and mixtures thereof. These materials provide to the walls of the tubular body a smooth surface facilitating on one hand the sliding of the prosthesis inside the tubular body and easing on the other hand the introduction of the device in the incision.

With reference to FIG. 4 is shown a flexible prosthesis 10 suitable for being introduced into a small incision and transported to an implantation site in open surgery thanks to the device 1 of the invention of FIG. 3. For example, the prosthesis 10 is textile based. The prosthesis 10 may be formed of a mesh 11, of globally oval shape on the example shown. The prosthesis 10 is reinforced with a frame 12.

On the example shown, the mesh 11 may be made from a knitted, woven or non-woven arrangement of biocompatible threads. This mesh 11 is sufficiently flexible to be folded when the prosthesis is introduced into the abdominal cavity 109 via the incision 110. However, the mesh is generally a textile having no elasticity enabling it to return to a spread out configuration of its own accord after it has been folded up. Such meshes are well known to the person skilled in the art and are not described in more detail here. The mesh may be supplied in the form of a strip that is cut to the dimensions of the defect to be treated. In the example represented, the mesh 11 has an oval shape. In other embodiments, the mesh may be of rectangular or square shape, or any shape adapted to the defect to be treated.

On the example shown, the frame 12 substantially adopts the shape of the exterior peripheral edge of the mesh 11. The frame 12 is resilient, so as to allow the prosthesis 10 to move from a compact configuration, in which it is folded up on itself and in which it occupies a small volume, to a spread out configuration, as shown on FIG. 4, corresponding to the implantation configuration.

With reference to FIG. 5, is shown the step before introduction of another embodiment of a prosthesis 200 into the device of FIG. 3.

The prosthesis 200 comprises a biocompatible textile 202 and a reinforcing element in the form of a frame 203.

The textile 202 has a generally elongate shape, similar to an oval or egg shape, defining a longitudinal axis A and a transversal axis B. In an implanted configuration of the prosthesis 202 of FIG. 5, the longitudinal axis A is aligned on the medial-lateral axis of a human body and the transversal axis B is aligned on the cranial-caudal axis of a human body.

The textile 202 is thus delimited by a peripheral outer edge 204. The textile 202 comprises a medial end 202 a, a lateral end 202 b, a cranial part 202 c and a caudal part 202 d. The peripheral outer edge 204 is therefore formed of a convex medial edge 204 a, a convex cranial edge 204 c, a convex lateral edge 204 b and a convex caudal edge 204 d.

In the example shown, the textile 202 has the general shape of the section of an egg by a longitudinal plane. Such a shape is particularly suitable for the repair of an inguinal hernia. In particular, the cranial part 202 c of the textile 202 is designed and shaped so as to efficiently cover the anterior muscle wall, the upper part of the os pubis and Cooper's ligament, while the caudal part 202 d of the textile 202 is designed and shaped so as to cover efficiently the iliac vessels and spermatic vessels and part of the psoas muscle. In this view, the cranial part 202 c is generally larger than the caudal part 202 d. In addition, the medial end 202 a has a rounded configuration that makes it capable of overlying and covering the orifice of the inguinal canal. The lateral end 202 b has also a rounded configuration, but of smaller size than the medial end 202 a, as it is located away from the orifice of the inguinal canal in an area where less foreign material is needed and desired.

In other embodiments, the textile 202 could have a globally oval or rectangular shape or could be protean if the shape in question is generally elongate and is adapted to cover the hernia defect in the inguinal region as explained above.

The textile 202 is made up of an arrangement of biocompatible filaments, such as a knit, a woven or a nonwoven. The textile 202 may be in the form of a mesh, that is to say it has openings for better tissue integration. For example, the textile 202 can be a two-dimensional or three-dimensional knit. Such textiles in the form of meshes or knits are well known to a person skilled in the art and are not described in any greater detail here.

The textile 202 can be bioresorbable, permanent or partially bioresorbable. As will become clear from the description below, the textile 202 is sufficiently flexible to be folded up, in particular at the time of introduction of the prosthesis into the device of the invention, along at least one folding direction. In general, however, the textile 202 does not have an inherent elasticity allowing it to spontaneously recover a spread-out configuration once it has been folded up. The textile 202 can be supplied in the form of a band, which one cuts to the dimensions of the defect to be treated.

The frame 203 acts as an element reinforcing the textile 202 in order to stiffen the latter and keep it in its generally elongate shape, as a tool for guiding the prosthesis 200 at the time of its introduction into the tubular body 2 of the device 1 of the invention, and as a tool for assisting in the deployment of the prosthesis 200 when the prosthesis 200 reaches the implantation site. For this purpose, the frame 203 is connected to the textile 202 and has an elasticity allowing it to be deformed under the effect of a temporary stress and allowing it to return to an initial state of rest once said stress has been removed.

The frame 203 is connected to the textile 202. It can be attached to the textile 202 by means of a seam, or else by means of an ultrasonic weld, by adhesive bonding, or by injection moulding.

In one embodiment, the frame 203 is connected to the textile 202 by injection moulding of one or more thermoplastic or thermosetting biocompatible materials. Such an embodiment makes it possible to secure the fixing of the frame to the textile in a particularly effective manner and to produce the prostheses according to the invention at an industrial scale.

In the injection moulding technique, a mould is formed in which, for example, there is a cavity defining a contour which corresponds to the contour of the frame that is to be obtained. The textile is held in an insert gate of the mould. The thermoplastic material used to produce the frame, for example a copolymer of polylactic acid and of polyglycolic acid, is heated and injected into the cavity using an injection moulding machine.

After the injection step, the mould is opened and the prosthesis 1 is withdrawn from the mould. Such a method allows the textile to be “embedded” in the part moulded over it. Thus, the frame 203, which is the overmoulded part, is connected to the textile, without any risk of its coming loose or fragmenting. The frame 203 is slightly set back from the peripheral convex outer edge 204.

Still with reference to FIG. 5, the frame 203 comprises a first segment which is a convex cranial segment 203 c and which extends from the medial end 202 a of the textile 202 to the lateral end 202 b of the textile 202 substantially parallel to the convex cranial edge 204 c. The frame 203 further comprises a second segment which is a caudal segment 203 d substantially extending from the medial end 202 a of the textile 202 to the lateral end 202 b of the textile 202 and caudally spaced with respect to the convex cranial segment 203 c. The frame 203 further comprises a lateral corner segment 203 b joining together the convex cranial segment 203 c and the caudal segment 203 d in the region of the lateral end 202 b of the textile 202.

Eventually, always with reference to FIG. 5, the frame 203 comprises a last segment which is a folding segment 205 configured for joining the medial end of the convex cranial segment 203 c to the medial end of the caudal segment 203 d. The frame 203 encompasses all these segments, convex cranial segment 203 c, lateral corner segment 203 b, caudal segment 203 d and folding segment 205, in a continuous way. The frame 203 is therefore continuous. The shape of the frame 203 leaves the region of the medial end 202 a of the textile 202 free of any frame structure. On the example shown, the folding segment 205 is a U shaped body 207 extending towards a center of the textile.

Thus, in the example shown in FIG. 5, the folding segment (205, 207) defines a sort of mouth of the frame 203 in the medial end 202 a of the textile 202. The presence of this mouth allows an easy folding of the textile 202 and therefore of the prosthesis 200 when a pressure, such as the force F shown on FIG. 5 is exerted on the frame 203. This pressure allows reducing the volume occupied by the prosthesis 200 in the transversal direction.

In addition, because of the frame 203 being continuous, the step of pressing the prosthesis 200 together, by pressing the frame 203 together towards the longitudinal axis A of the prosthesis 200, does not create any projecting elements that could potentially perforate and damage the tissues. By virtue of its nature and its shape, the frame only has rounded and atraumatic outer contours.

In particular, the frame 203 has a structure, in other words a shape, and a nature, in other words a material, giving it an elasticity such that it is able to adopt a first, unstressed configuration in which the textile 202 and the prosthesis 200 are deployed and spread out as shown in FIG. 5, and a second, stressed configuration in which the frame 203 is subjected to a transversal force directed towards said longitudinal axis A and the convex cranial segment 203 c, the caudal segment 203 d and the folding segment 205 are substantially collected together and aligned on one folding direction, the textile 202 forming thereby at least one fold along the folding direction, as shown on FIG. 6.

As shown on FIG. 5, at least a part of the frame 203 has substantially the structure of a flat band forming undulations substantially in the plane of the textile 202. Such undulations allow a good conformability of the prosthesis. Such undulations further confer flexibility to the frame 203. In addition, such undulations confer a good resistance to folding to the prosthesis 200.

The caudal segment 203 d may be concave. For example, the cranial part 202 c is substantially planar and large enough so as to cover the anterior muscle wall, the orifice of the inguinal canal, the upper part of the os pubis and Cooper's ligament. The concavity of the caudal segment 203 d confers to the caudal part 202 d of the textile 202 an undulated and anatomical developed shape for matching the general shape of the lower inguinal structures, especially the spermatic and iliac vessels and the psoas muscle. The concavity of the caudal segment 203 d gives the caudal part 2 d a curved shape, this caudal part 202 d thus forming with the cranial part 202 c an angle corresponding to the angle formed by the parietal and vascular planes at the intersection thereof in the inguinal region of a human body. Thus, the cranial part 202 c and the caudal part 202 d are asymmetrical, which means that a left-hand prosthesis or right-hand prosthesis will be used depending on which side the hernia to be treated is located.

Still with reference to FIG. 5, the frame 203 further comprises a caudal extension 208 located on the caudal segment 203 d and extending in the caudal direction substantially up to the caudal edge 204 d of the textile 202. The caudal extension 208 helps deploying the caudal part 202 d of the textile 202 once the prosthesis 200 is implanted. This caudal extension 208 helps spreading out the caudal part 202 d of the textile on the biological tissues it is intended to cover, namely the iliac and spermatic vessels and part of the psoas muscle.

In order to proceed to the insertion of the prosthesis 200 into the device 1 of FIG. 5, the surgeon (not shown) folds the prosthesis 200 on itself by applying a pressure on the prosthesis 200 represented by the arrows F on FIG. 5. He then approaches the prosthesis 200 from the proximal end 2 a of the device 1. Thanks to the proximal semi-tubular rounded extension 2 d, the introduction of the prosthesis 200 inside the tubular device 1 is facilitated, as described above. The surgeon then pushes on the prosthesis 200 in the distal direction. The prosthesis 200 automatically follows the walls of the partial funnel formed by the proximal semi-tubular rounded extension 2 d and it adopts a folded configuration within the tubular body 2, as shown on FIG. 6.

The surgeon then may introduce the distal end 2 b of the device 1 inside the incision 110 (FIG. 2). As described above, this introduction is facilitated by the rounded shape of the distal semi-tubular extension 2 c. The tubular body 2 then forms a barrier between the prosthesis 200 and the incision 110 edges. Thanks to the presence of the ruler, the surgeon can determine if has completed a long enough dissection. In addition, the device 1 of the invention allows standardizing the gesture of the surgeon, as the surgeon is ensured to introduce the distal end of the tubular body 2 at the right depth in the body of the patient, and therefore at the precise location of the implantation site.

When the surgeon has introduced the distal end of the device 1 at the right depth as described above, he pushes distally on the prosthesis 200 which slides easily inside the tubular body 2 thanks to the open longitudinal slit 3.

When the prosthesis 200 has substantially reached the distal end of the tubular body 2 and therefore the implantation site, the surgeon then ejects the prosthesis 200 from the device 1 by maintaining the prosthesis 200 fixed with respect to the body of the patient while he removes the device 1 by pulling said device 1 in the proximal direction. During this step, the surgeon may access directly to the prosthesis 200 with one of his hand thanks to the longitudinal slit 3 of the tubular body 2. The open shape of the distal end 2 b of the tubular body, thanks to the presence of the distal semi-tubular extension 2 c, allows the prosthesis 200 to start spreading out as it emerges from the tubular body 2 at the implantation site.

The device 1 of the invention therefore facilitates the introduction of a flexible prosthesis in an incision of very small size, such as for example an incision of 3 or 4 cm long, in open surgery procedure without necessitating the use of any dedicated ancillary device. The device of the invention may be of great help to the surgeon for dissecting a pocket of adequate size in the first place and therefore save time and potential infection. 

The invention claimed is:
 1. A kit comprising: a prosthesis comprising a generally elongate shape defining a longitudinal axis aligned on a medial-lateral axis and a transversal axis aligned on a cranial-caudal axis, the prosthesis comprising at least one flexible biocompatible textile of elongate shape comprising a medial end, a lateral end, a cranial part and a caudal part, the textile being delimited by a peripheral outer edge formed of a convex medial edge, a convex cranial edge, a convex lateral edge and a caudal edge, and at least one reinforcing element for the textile, the reinforcing element being in the form of a resilient frame connected to the textile and set back from the peripheral outer edge, the frame comprising a convex cranial segment extending from the medial end of the textile to the lateral end of the textile along the convex cranial edge, a caudal segment substantially extending from the medial end of the textile to the lateral end of the textile and caudally spaced with respect to the convex cranial segment, a lateral corner segment joining together the convex cranial segment and the caudal segment in a region of the lateral end of the textile, and a folding segment configured for joining a medial end of the convex cranial segment to a point located on the caudal segment while leaving a region of the medial end of the textile free of any frame, wherein at least a part of the caudal segment has substantially a structure of a flat band forming undulations substantially in a plane of the textile and a device comprising a globally tubular body having a proximal end, a distal end, a substantially oblong cross-section, and an open longitudinal slit extending from the proximal end to the distal end, and the tubular body designed for receiving the prosthesis in a folded configuration in a sliding way.
 2. The kit according to claim 1, wherein the frame is able to adopt an unstressed configuration, in which the textile is deployed, and a stressed configuration, in which the frame is subjected to a transversal force directed towards the longitudinal axis, and the convex cranial segment, the caudal segment and the folding segment are substantially collected together and aligned on one folding direction, the textile forming thereby at least one fold along the folding direction.
 3. The kit according to claim 2, wherein the folding segment joins the medial end of the convex cranial segment to a medial end of the caudal segment.
 4. The kit according to claim 1, wherein the caudal segment is concave.
 5. The kit according to claim 1, wherein the folding segment has a U shape extending towards a center of the textile.
 6. The kit according to claim 1, wherein the frame is continuous.
 7. The kit according to claim 1, wherein the frame further comprises a caudal extension located on the caudal segment and extending in the caudal direction toward the caudal edge of the textile.
 8. The kit according to claim 1, wherein the reinforcing element is molded over the textile.
 9. The kit of claim 1, wherein the proximal end of the device forms a partial funnel.
 10. The kit of claim 1, wherein the distal end of the device includes a rounded extension.
 11. The kit of claim 1, wherein the device further comprises markings defining a ruler along the open longitudinal slit.
 12. The kit of claim 1, wherein the tubular body of the device is made of a transparent material.
 13. A kit comprising: a flexible textile based prosthesis for hernia repair, and a device for introducing the flexible textile based prosthesis into a surgical incision, the device comprising a globally tubular body having a proximal end provided with a proximal semi-tubular extension, a distal end provided with a distal semi-tubular rounded extension, a substantially oblong cross-section, and an open longitudinal slit extending from the proximal end to the distal end, wherein the open longitudinal slit widens on the proximal semi-tubular extension and the distal semi-tubular rounded extension.
 14. The kit of claim 13, wherein the flexible textile based prosthesis comprises a generally elongate shape defining a longitudinal axis aligned on a medial-lateral axis and a transversal axis aligned on a cranial-caudal axis.
 15. The kit of claim 14, wherein the flexible textile based prosthesis comprises a medial end, a lateral end, a cranial part and a caudal part, the textile based prosthesis being delimited by a peripheral outer edge formed of a convex medial edge, a convex cranial edge, a convex lateral edge and a caudal edge, and at least one reinforcing element for the textile based prosthesis, the reinforcing element being in the form of a resilient frame connected to the textile based prosthesis and set back from the peripheral outer edge.
 16. The kit of claim 14, wherein the resilient frame comprises a convex cranial segment extending from the medial end of the textile to the lateral end of the textile along the convex cranial edge, a caudal segment substantially extending from the medial end of the textile to the lateral end of the textile and caudally spaced with respect to the convex cranial segment, and a folding segment configured for joining a medial end of the convex cranial segment to a point located on the caudal segment while leaving a region of the medial end of the textile free of any frame.
 17. The kit of claim 16, wherein the resilient frame is able to adopt an unstressed configuration, in which the textile is deployed, and a stressed configuration, in which the resilient frame is subjected to a transversal force directed towards the longitudinal axis, and the convex cranial segment, the caudal segment and the folding segment are substantially collected together and aligned on one folding direction, the textile forming thereby at least one fold along the folding direction.
 18. The kit of claim 14, wherein the resilient frame is continuous.
 19. The kit of claim 13, wherein the device comprises markings defining a ruler along the open longitudinal slit.
 20. The kit of claim 13, wherein the tubular body of the device is made of a transparent material. 